Danazol in Idiopathic Thrombocytopenic Purpura

D, Almagro

doi:10.1159/000206184

Cited by 27 publications

(13 citation statements)

References 1 publication

(1 reference statement)

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“…Since lications on danazol in ITP [9-20], 9 of which con firmed our findings [9-17], but 3 described negative results [18][19][20], In all 3, the duration of therapy was limited to 2-3 months, i.e. inadequate for a full evalu ation.…”

supporting

confidence: 68%

“…Most patients (71%) responded within 2 months of therapy, but 29% had delayed responses up to 10 months [21]. Thus, a 2-month trial, as was used in the negative reports [18,19], would be inadequate for de termining this drug's efficacy.…”

Section: Optimal Dosage and Duration O F Therapymentioning

confidence: 99%

“…In addi tion, since age and sex markedly influence the re sponse to danazol (e.g. 18% response rate in younger women vs. 82% in older women), the different patient compositions of the three small groups [18][19][20] may have contributed to the negative finding. The con troversy arising from negative findings in a minority of reports is clarified in our recent report on a larger number of patients [21], A tripling of platelet counts with sustained remission was observed in 58 of 96 pa tients, most of whom had been weaned entirely from glucocorticoids.…”

mentioning

confidence: 99%

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Efficacy of Danazol in Hematologic Disorders

Ahn¹

1990

Acta Haematol

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Danazol, an attenuated androgen developed for the treatment of endometriosis, has recently been found useful in the treatment of several hematologic disorders, including idiopathic thrombocytopenic purpura (ITP), autoimmune hemolytic anemia (AIHA), paroxysmal nocturnal hemoglobinuria, myelodysplastic syndrome, and others. Our studies of the past 6 years have demonstrated that danazol is advantageous in the treatment of AIHA, and in specifically defined populations of ITP patients. Of 96 ITP patients treated with danazol 61% overall had excellent/good responses, but this rate varied markedly with prognostic factors, e.g. 82% in older women versus only 18% in younger women. Of 28 AIHA patients, 77% with idiopathic type and 60% with secondary type were excellent/good responders. When the drug was discontinued after 1 year or more of therapy, lasting unmaintained remissions of up to 5 years were often observed in both ITP and AIHA, a notably important benefit. The side-effects of danazol are generally much less serious than with glucocorticoids. Glucocorticoids can be tapered off and in most cases discontinued completely with danazol therapy in AIHA and chronic ITP. Approximately one third of ITP patients who failed on glucocorticoids are successfully maintained on danazol. Its mechanism of action in these disorders is currently under study in our laboratory, stimulated by new findings. Tentatively, danazol appears to modify cell membranes in a manner leading to specific immune modulations, as discussed. Further study is warranted to explore its application to other autoimmune and membrane-related disorders, and to clarify its mechanism of therapy.

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supporting

confidence: 68%

Section: Optimal Dosage and Duration O F Therapymentioning

confidence: 99%

mentioning

confidence: 99%

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Efficacy of Danazol in Hematologic Disorders

Ahn¹

1990

Acta Haematol

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“…There have been twenty-five publications on danazol therapy in ITP [48][49][50]. Twenty-one reported favorably on the value of danazol in ITP while 4 reported negative outcomes [59,60,67,69]. In most negative studies, danazol was used in a small number of patients as a single agent, and was discontinued afler 2-4 months.…”

Section: More On Danazol Therapymentioning

confidence: 99%

Idiopathic thrombocytopenic purpura: Pathophysiology and management

Ahn

Horstman

2002

Int J Hematol

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Our understanding of the pathophysiology of ITP owes to pioneering work of W J Harrington in 1951, delineating the immunologic nature of platelet destruction. In ITP, antibody-coated platelets are destroyed by macrophages of RES. However, other mechanisms are also implicated: C-mediated platelet lysis and newly described C-independent peroxide injury. Both induce platelet fragmentation and lysis, generating procoagulant platelet microparticles (PMP). A third mechanism of platelet consumption in the microvasculature is proposed, based on overlapping syndromes of ITP and TTP in some patients. In assessing hemostasis in ITP, platelet counts alone is not sufficient. Evaluation of platelet clumping, giant platelets, and platelet activation, marked by increased PMP is useful. Patients with platelet activation or giant platelets bleed less and detection of clumping prevents unwarranted therapy. Thrombotic complications may develop in ITP. A syndrome, characterized by recurrent TIA-like symptoms, progressive memory loss due to ischemic small vessel disease is described. The management of ITP should include the search for and elimination of underlying causes and careful evaluation of hemostasis. Therapy is divided into definitive vs symptomatic measures. The former including splenectomy, danazol, chemotherapy offers lasting remission after therapy was stopped, while the later including glucocorticoids, gammaglobuin, antiD antibodies and others increases platelet counts but seldom sustains remission upon withdrawal. Danazol therapy is up-dated since it is an effective and safe definite measure in ITP.

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“…A vincristina é uma droga que induz respostas favoráveis em 11% a 70% dos casos após dois a cinco ciclos semanais, em doses de 1,0 a 2,0 mg 7, 83,110 .…”

Section: Vincristinaunclassified

Resposta da púrpura trombocitopênica idiopática à esplenectomia tardia.

Bassitt¹

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Danazol in Idiopathic Thrombocytopenic Purpura

Cited by 27 publications

References 1 publication

Efficacy of Danazol in Hematologic Disorders

Efficacy of Danazol in Hematologic Disorders

Idiopathic thrombocytopenic purpura: Pathophysiology and management

Resposta da púrpura trombocitopênica idiopática à esplenectomia tardia.

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